Runners with patellofemoral pain demonstrate sub-groups of pelvic acceleration profiles using hierarchical cluster analysis: an exploratory cross-sectional study

Ricky Watari, Sean T. Osis, Angkoon Phinyomark, Reed Ferber

Previous studies have suggested that distinct and homogenous sub-groups of gait patterns exist among runners with patellofemoral pain (PFP), based on gait analysis. However, acquisition of 3D kinematic data using optical systems is time consuming and prone to marker placement errors. In contrast, axial segment acceleration data can represent an overall running pattern, being easy to acquire and not influenced by marker placement error. Therefore, the purpose of this study was to determine if pelvic acceleration patterns during running could be used to classify PFP patients into homogeneous sub-groups. A secondary purpose was to analyze lower limb kinematic data to investigate the practical implications of clustering these subjects based on 3D pelvic acceleration data. A hierarchical cluster analysis was used to determine sub-groups of similar running profiles among 110 PFP subjects, separately for males (n = 44) and females (n = 66), using pelvic acceleration data (reduced with principal component analysis) during treadmill running acquired with optical motion capture system. In a secondary analysis, peak joint angles were compared between clusters (α = 0.05) to provide clinical context and deeper understanding of variables that separated clusters. The results reveal two distinct running gait sub-groups (C1 and C2) for female subjects and no sub-groups were identified for males. Two pelvic acceleration components were different between clusters (PC1 and PC5; p < 0.001). While females in C1 presented similar acceleration patterns to males, C2 presented greater vertical and anterior peak accelerations. All females presented higher and delayed mediolateral acceleration peaks than males. Males presented greater ankle eversion (p < 0.001), lower knee abduction (p = 0.007) and hip adduction (p = 0.002) than all females, and lower hip internal rotation than C1 (p = 0.007). Two distinct and homogeneous kinematic PFP sub-groups were identified for female subjects, but not for males. The results suggest that differences in running gait patterns between clusters occur mainly due to sex-related factors, but there are subtle differences among female subjects. This study shows the potential use of pelvic acceleration patterns, which can be acquired with accessible wearable technology (i.e. accelerometers).